The demand for emergency care has risen from 90 million patient visits in 1997 to 120 million in 2007. Much attention has been paid to the shortage of qualified Emergency Physicians (EP), yet little attention has been paid to EP productivity, measured in patients per hour (pph), which has remained constant for the past 30 years.
Information plays a key role in modern medicine. Physicians and nurses depend on quick and reliable access to key information such as vital signs and lab results. The current systems used by the Emergency Department (ED) include paper charting or “health information technology” (HIT). These systems require physicians and nurses to waste time and effort searching for information or copying information from one system to another, introducing errors and fatal inconsistencies along the way.
Waiting times have consistently increased over the past decade, in particular the wait time before a patient is evaluated by a physician (so-called “door-to-physician time”). Although the total cost to society is difficult to quantify, a recent lawsuit involving the unexpected death of a celebrity's brother several hours after checking into an ED illustrates this point; delays in the ED are associated with increased death, disability, and litigation.
A competent EP can typically process 2-3 pph during a shift that typically lasts 8-12 hours, sometimes up to 24 hours. This rate has remained constant over the past 30 years. This bottleneck is so universal that some cannot fathom an EP seeing more than 2.5 pph safely. Currently available HIT has not consistently decreased door-to-physician time. In fact, many early adopters of ED HIT, such as paperless charting systems and Computerized Physician Order Entry (CPOE), have sustained decreases in physician throughput. Much HIT currently deployed in EDs not only impedes workflow, but also increases error rate and endangers patient safety. Finally, the statistics released in support of expensive HIT are rarely from controlled or blinded studies designed to prove benefit, but rather from anecdotal materials designed to market a product.
Communication of urgent information between physicians and nurses quickly becomes a logistic problem, and many EDs in the United States provide extension-based cordless phones to their employees for use during shifts. These phones clip onto scrub pants or fit into labcaot pockets; they are often called “pickle phones” due to their distinctive shape. Each phone costs $500-$800, and provides extremely limited functionality (caller ID, call hold, rudimentary text messaging, dial-by-number, minimal data integration or entry).